Suturing instrument

ABSTRACT

A surgical suturing instrument for applying sutures to a wound or the like comprising a first handle movably mounting a second handle which is operable to rotate a shaft when moved from a first position to a second position. Needle means including a needle is affixed to the shaft so that movement of the second handle affects rotation of the needle. Provided in the needle is a suture-retaining slot which carries a suture so that as said needle is rotated through tissue it automatically threads the sutures.

United States Patent Akuba [54] SUTURING INSTRUMENT [72] Inventor: Uche Akuba, 30 Park Ave., Suite 19F, New York,N.Y. 10016 [22] Filed: July 11, 1969 211 Appl. No.: 841,051

521' vs. C1 ..l28/340, 112/80 [51] Int. Cl. ..A6lb 17/04, DOSb 91/00, D05c 15/00 [58] Field of Search ..1 12/80, 169; 128/339, 340; 223/104 [56] References Cited UNITED STATES PATENTS 194,759 9/1877 Atwood ..1 12/169 UX 1,055,058 3/1913 Leighton...

2,737,954 3/1956 Knapp ..128/340 [451 Feb. 1,1972

3,038,475 6/1962 Orcutt ..128/339 3,090,386 5/1963 Curtis .128/340 X 3,168,097 2/ l 965 Dormia ..128/340 Primary Examiner-Channing L. Pace ArtorneyPaul Fields [57] ABSTRACT A surgical suturing instrument for applying sutures to a wound or the like comprising a first handle movably mounting a second handle which is operable to rotate a shaft when moved from a first position to a second position. Needle means including a needle is affixed to the shaft so that movement of the second handle affects rotation of the needle. Provided in the needle is a suture-retaining slot which carries a suture so that as said needle is rotated through tissue it automatically threads the sutures.

10 Claims, 10 Drawing Figures PATENIEBEB mzz -3.638,654

INVENTOR. Uche Akuba ATTORNEY SUTURING INSTRUMENT This invention relates generally to a surgical suturing instrument and, more particularly, pertains to a device for quickly and easily applying sutures to a wound or the like.

Presently used techniques for suturing opentissuedue to a woundoran operation or .the like have a number of drawbacks. To be more specific, an example of a suturing method includes the. use .ofa curvedneedle and a plurality of forceps. The suture is threaded through the needle eye. One. lip of the open tissue is grasped with one set of forceps and the needle is manipulated with a second set of forceps to pierce the tissue at a point adjacent to the opening. The needle is then .released and is grasped on the other side of the tissue with the forceps and is pulled through. the tissue thereby carrying the suture throughthe tissue orskin. This procedure is continued for the' opposite lip of the opening and is repeated until the opening or wound has been completely closed. In view of the difficulties involved in placing and manipulating the needle, the use of thismethod is usually time consuming; Additionally, it is to be noted that the needle is supportedonly by the tissue during the time that the needle is released and is again grasped. on theexit side of the tissue. As a result it has been found that the needle maymove in the tissue duringthe interval .it is unsupported thereby risking damage to the tissue, as well as loss of the needle-itself.

A further disadvantage resides in the fact that the needle must pass completely through the tissue. since the suture is connected to the rear of the needle. This introduces a further risk of damaging the tissue since the complete passageof the needle tends to widen the punctiform passage formed thereby. Moreover, this drawback is compounded further by the fact thatmany'suturing procedures must be carried out at some distance from the operator in conditions of poor visibility, such as at the'bottom of a bladder,.so-that the accurate placement and withdrawal of the needle becomes difficult.

One furtherdisadvantage of the above-described method is that the needle must be grasped tightly by the forceps which, in many cases, results in fracture and breakage of the needle. On the other hand, if the needle is loosely retained by the'forceps it rocks back and forth and gets out of position thereby delaying the. closing-of the wound and/or damaging the tissue.

Accordingly, an object of the invention is to provide an improved suturingdevice.

A more specificobject of the invention is to provide a suturing .device. or instrument which may be quickly and easily operated to pierce tissue.

A further object of the invention resides in the novel details of construction which provide a suturing instrument of the type described in which the needle is always'under the control of the operator.

Another object of the invention residesin the provision of a suturing instrumentor device whichincludes a needle portion which may be accurately positioned to eliminate anyunnecessary damage to the. tissue due to inaccurately positioned needles.

A further object of the invention is the provision ofa sutur. ing instrument of the type describecllwhich eliminates-the need for the completerpassage. of the needlethrough the'tissue. thereby eliminating unnecessary widening of the needle.

passage.

Accordingly, a surgical suturing instrument constructed according to the present inventionincludes a first handle which movably mounts a second handlesA rotatable shaft is pro-- vided and motion-transmittingmeans interconnects the shaft and the second handle whereby movement of the second ban-- the second handle effects'rotationof. the needle. The needle includes suture-retaining means for receiving a'suture'therein so that.as..=.the'needle pierces.;tissue.:thewsuture is carried therewith and is automatically. threaded through the tissue.

A feature of the present invention is to provide a suturing instrumentfor easily applying sutures to a wound or the like whichincludes an operating member which mounts a needle thereby eliminating the need for an external forceps to hold the needle during the tissue-piercing operation.

Other features and advantages of the present invention will become more apparent from a consideration of the following detailed'description when taken in conjunction with the accompanying drawing, in which:

FIG. 1 is a perspective view of a surgical suturing instrument constructed in accordance with the present invention, with a portion broken away in the interests of clarity;

FIG. 2 is a sectional view thereof taken along the line 22 of FIG. 1;

FIG. 3 is a sectional detail view illustrating one form of the connection between the handle and the rotatable needle support;

FIG. 4 is a sectional view taken along the line 4-4 of FIG.

FIG. 5 is a front elevational view of a needle constructed according to the present invention;

FIG. 6 is a sectional view thereof taken along the line 6-6 of FIG..5;

F IG. 7 is a front elevational view of a modified embodiment of the needle forming a part of the suturing instrument of the present invention;

FIG. 8 is a sectional view thereof taken along the line 8-8 of FIG. 7;

FIG. 9 is a detail view, to an enlarged scale, of an arrangement for fastening a needle to the needle mount; and

FIG. 10 is an enlarged detail view of the end portion of a needle which is received in the needle mount.

Accordingly, the surgical suturing instrument or device constructed according to the present invention is designated generally by the reference numeral 10 in the figures and includes a first or main handle 12. More specifically, the handle 12 is hollow and includes a thumb-receiving portion 14, an enlarged intermediate portion 16 and a shaft support portion 18 whichextends outwardly from the intermediate portion 16. Rotatably supported in 'a central bore 20 in the shaft support portion 18, by appropriate ball bearings or the like (not shown), is a shaft 22. Fixedly received in the shaft 22, adjacent to the forward end thereof is a radially extending cross member 24. Fixedly received on the other end of the shaft 22 is a pinion gear 26. The pinion 26 is in meshing engagement with an arcuate or segmental gear 28 which, in turn, is rotatably mounted within the enlarged intermediate portion 16ofthe handle 12.

More particularly, the gear 28 is supported between radial arms 30 which are connected to a hub 32. A pivot pin 34 extends through the center of the hub 32 and is connected to opposite sides of the handle 12 thereby to pivotally mount the gear 28within the portion 16. Also connected to the hub 32 is an operating or second handle 36. As shown in FIG. 2, the handle 36 includes a-bent section 38 which extends outwardly and downwardly from the hub 32 through a slot 40 in the bottom of thehandle l2 and a rearwardly extending section 42. The handle 36'is slightly concave downwardly to follow the natural curvature of the fingers when the instrument is in use to facilitate theoperation thereof. Additionally, the handle 36 is provided with a depending hooked finger rest 44.

The thumb-receiving portion 14 of the handle 12 is provided with a substantially elliptical aperture 46 on the far surface of the handle which includes a rear curved portion 48 havinga relatively large radius of curvature and an upper forward curved portion 50 having a small radius of curvature. The near surface of the handle 12 is provided with a substantially elliptical aperture 52 similar to the aperture 46. However, theforward curved surface 54 of the aperture 52 extends beyondthe forward curved surface 50 of the aperture 46 and is connected thereto by a sloping or inclined wall 56. Ac-

h cordingly, the apertures 46 and 52 and the connecting wall form a thumb'hole 58.

It is to be noted that the instrument shown in FIGS. 1 and 2 is a so-called left-hand suturing instrument which is to be utilized by left-handed surgeons. Accordingly, when an operator desires to use the instrument he inserts his thumb through the thumb hole 58. The sloping wall 56 abuts the meaty or fleshy base portion of the thumb while the fingers curl around the handle 36 and the index finger abuts the hooked finger rest 44. Hence, since the wall 56 abuts the fleshy part of the thumb the operator of the instrument can maintain a great deal of control over the instrument and hold the same relatively steady while it is in use. It will be obvious, however, that for right-handed operators, the sloping wall 56 will be reversed so that it is inclined forwardly from the near surface of the handle 12 to the far surface of the handle 12, as taken in FIG. 2.

When the operator closes his fingers to move the handle 36 toward the handle 12, the gear 28 will move in the direction indicated by the arrowhead 60. Hence, the shaft 22 will rotate in the direction indicated by the arrowhead 62. Additionally, a coil spring 64 is provided which encircles the hub 32 and is connected to the upper arm 30 at one end and abuts the lower wall of the handle 12 at the other end to normally bias the gear 28 to the position shown in FIG. 2. Movement of the gear 28 to this position is limited by the engagement of the bent portion 38 of the handle 36 with the end of the slot 40. Further, a setscrew 66 is provided which is threadedly received in the upper and lower walls of the handle 12 and extends through the lower wall thereof into the path of movement of the handle 36. The setscrew 66 may be rotated to move the same axially, wither upwardly or downwardly, as indicated by the doubleheaded arrowhead 68 to limit the upward movement of the handle 36 and, consequently, to limit the angle of rotation of the shaft 22 for the reasons noted below.

Rotatably mounted on the shaft support portion 18 is a needle mount designated generally by the reference numeral 70. To be more specific, the needle mount includes a rear cylindrical portion 72 and a forward truncated conical portion 74. The rear end of the portion 72 is provided with a recess 76, as shown in FIG. 3, which receives a reduced diameter end portion 78 of the shaft support portion 18 of the handle 12. As shown in FIG. 4, the portion 18 is provided with radially extending bores 80 which receive balls 82 which, in turn, are biased outwardly by biasing springs 84. The recess 76 is provided with an annular groove 86, as shown in FIG. 3, which receive the balls 82 to retain the needle mount 70 on the shaft support portion 18 of the handle 12. In other words, the needle mount 70 is connected to the shaft support portion 18 by pressing the needle mount rearwardly on the reduced diameter portion 78. This action depresses the balls 82 against the spring 80. However, when the needle mount 70 is firmly seated on the reduced diameter portion 78, the springs 84 again bias the balls outwardly and into the annular groove 86 to prevent separation of the needle mount 70 and the shaft support portion 18. The opening of the bores 80 is made slightly smaller than the diameter of the balls 82 so that the balls 82 are retained in the bores 80 to prevent their loss when the needle mount 70 is removed.

The needle mount 70 is provided with opposed grooves 88 which extend forwardly from the rear edge thereof. The grooves 88 receive the cross member 24 therein so that rotation of the shaft 22 effects rotation of the needle mount 70.

The needle mount 70 is provided with a substantially rectangular transverse through opening 90 adjacent the end thereof. The opening 90 is adapted to receive the complementary formed end 92 of a needle 94 (FIG. therein. In other words, the end 92 of the needle 94 is inserted into the opening 90 in the needle mount 70 when the needle is connected to the needle mount. The needle is affixed in place by a setscrew 96 which is threaded into the truncated end of the conical portion 74 of the needle mount 70. That is, when the needle 94 is inserted into the opening 90, the set screw 96 is tightened so that it abuts the end 92 of the needle to retain the same in place. When it is desired to remove the needle, the set screw 96 is loosened so that the needle easily may be removed.

FIGS. 5 and 6 illustrate an atraumatic needle 98 which forms a part of the present invention. The needle 98 is provided with an end 100 which is similar in construction to the end 92 of the needle 94 illustrated in FIG. 10 so that the needle 98 may be connected with the needle mount 70. The needle 98 extends through an arc of approximately 270 and includes a conventional rounded body portion 102 which tapers to a pointed end 104. An open-ended slot 106 is provided in the needle 98 which extends to the inner wall of the needle. The slot 106 is positioned to the rear of the pointed end 104 and, in practice, is positioned approximately 3540 behind the end 104. The interior portion of the slot 106 is enlarged to receive a suture 108. The opening of the slot 106 is constricted and the bottom wall is closed to prevent accidental removal of the suture 108.

In practice, the needle end 100 is inserted into the opening 90 in the needle mount 70 and the set screw 96 is tightened to affix the needle in place. Thereafter, the cross member 24 is inserted into the grooves 88 in the needle mount 70 and the needle mount is mounted on the reduced diameter portion 76 of the shaft support portion 18 of the handle 12. It is to be noted that the needle 98 curves downwardly toward the right, as taken in FIG. 1. The suture 108 is then inserted into the slot 106 in the needle 98 and is positioned in the enlarged portion of the slot.

The handle 12 is grasped by the left hand, as noted above, with the thumb projecting through the thumb hole 58 and the wall 56 engaging the meaty or fleshy part of the thumb base. The setscrew 66 may be adjusted to limit the movement of the handle 36 and, accordingly, the degree of rotation of the needle 98 so that the needle rotates through a desired arc.

The two lips forming the opening in the tissue are compressed together and lifted slightly by an appropriate forceps. The instrument 10 is then positioned so that the end 104 of the needle 98 is adjacent the beginning of the wound or the opening. The operator then squeezes the handle 36 to rotate the shaft 22 in the direction indicated by the arrowhead 62, in the manner noted above. Since the shaft 22 is connected to the needle mount 70 via the cross member 24 and the grooves 88, the needle mount 70 and, consequently, the needle 98 will move in the direction indicated by the arrowhead 110 in FIG. 1. Hence, the needle 98 will pierce the tissue adjacent each side of the opening or wound thereby carrying the suture 108 through the tissue. The suture 108 is then removed through the constricted opening of the slot 106 and the handle 36 is released. When the pressure on the handle 36 is released the spring 64 biases the segmental gear 28 back to the normal position illustrated in FIG. 2. Thus, the shaft 22 and, therefore, the needle 98 will rotate in a direction opposite to the direction indicated by the arrowheads 62 and 110 whereby the needle 98 is removed from the tissue. In other words, the rotation of the needle 98 is reversed so that the needle is removed from the tissue while the suture 108 remains in place. This procedure is again repeated until the wound or opening has been sutured.

In practice, the elements comprising the suturing instrument 10 of the present invention may be fabricated from stainless steel or the like so that the entire instrument may be sterilized. However, in view of the fact that only the needle contacts the tissue of a patient, only the needle is required to be sterilized. Additionally, depending upon the size of the wound, the toughness of the tissue and the like, differently sized needles or different types of needles may be substituted for the needle illustrated in FIGS. 5 and 6.

For example, FIGS. 7 and 8 illustrate a modified embodiment of a needle 112 which is referred to as a cutting edge needle. As is conventional in cutting edge needles, the cross section of the needle is triangular in shape, as shown in FIG. 8. Additionally, the needle is provided with a substantially rectangular end 114, which is similar to the end 92 of the needle 94, which is adapted to be received in the opening 90 in the needle mount 70. The needle 112 subtends an arc of approximately 270 and is provided with a pointed piercing end 116. Approximately 30-45 behind the piercing end 116 is a suture-receiving slot 118 which receives the suture 108. Similarly to the slot 106, the slot 118 is provided with a constricted opening 120 through which the suture 108 passes and an enlarged interior bottom portion having a closed wall 122 in which the suture is retained during the piercing operation. It is to be noted that the section of the needle 112 containing the slot 118 is rounded at 124 to facilitate passage of the needle outwardly of the tissues after the suture has been located in place.

The needle 112 is utilized in the same manner as the needle 98. That is, the needle 112 is connected to the needle mount 70 via the opening 90 and the setscrew 96. The suture 108 is inserted into the bottom portion 122 of the slot 118 and the instrument is operated so that the needle 112 pierces the tissue adjacent the opening of the wound or the cut thereby carrying the suture 108 with it. The suture 108 is then removed through the constricted opening 120 of the slot 118 and handle 36 is released to allow the needle 112 to rotate in the opposite direction and pass out of the tissue. As noted above, the portion 124 of the needle 112 is rounded to facilitate reverse travel of the needle without tearing any tissue.

Accordingly, a suturing instrument has been described which is extremely simple to operate and which permits control of the needle at all times during the suturing operation.

While preferred embodiments of the invention have been shown and described herein it will become obvious that numerous omissions, changes and additions may be made in such embodiments without departing from the spirit and the scope of the present invention.

What is claimed is:

l. A surgical suturing instrument comprising a first handle, a second handle movably mounted on said first handle, a rotatable shaft, motion-transmitting means interconnecting said shaft and said second handle whereby movement of said second handle from a first to a second position causes rotation of said shaft, and needle means including a needle and a needle mount affixed to said shaft and rotatable therewith whereby movement of said second handle affects rotation of said needle, said needle mount further including means for releasably and rigidly retaining said needle therein in tight frictional engagement therewith, said needle including suture retaining means for receiving a suture therein, said first handle being hollow and forming an enclosed housing, said motiontransmitting means being encased within said hollow handle housing and including a first gear connected to said second handle and being movable in response to movement of said second handle from said first to said second position, and a second gear connected to said shaft and in meshing engagement with said first gear to transmit motion of said first gear to said shaft.

2. A surgical suturing instrument as in claim 1, in which said first handle is provided with a thumb-receiving portion, said thumb-receiving portion including an inclined wall which slopes outwardly and forwardly from one surface of said first handle to the opposite surface of said handle and which is adapted to abut the fleshy base of the thumb when the suturing instrument is held in the hand of an operator.

3. A surgical suturing instrument comprising a first handle, a second handle movably mounted on said first handle, a rotatable shaft, motion transmitting means interconnecting said shaft and said second handle whereby movement of said second handle from a first to a second position causes rotation of said shaft, needle means including a needle affixed to said shaft and rotatable therewith whereby movement of said second handle affects rotation of said needle, said needle including suture retaining means for receiving a suture therein, said needle means further including a needle mount for releasably connecting said needle with said shaft, mounting means for mounting said needle mount on said first handle, and connecting means for connecting said needle mount with said shaft whereby said needle mount is rotatable with said shaft.

4. A surgical suturing instrument as in claim 3, in which said mounting means includes a reduced diameter portion extending outwardly from said first handle, a recess in said needle mount sized and positioned to receive said reduced diameter portion ofsaid first handle, and retaining means on said needle mount and said reduced diameter portion for retaining said needle mount on said reduced diameter portion.

5. A surgical suturing instrument as in claim 3, in which said connecting means includes a radially extending cross member connected to said shaft, and at least one slot in said needle mount adapted to receive said cross member therein.

6. A surgical suturing instrument as in claim 3, in which said needle mount includes an opening having a predetermined geometric shape adjacent the end thereof, said needle having an end formed complementary to said needle mount opening and being adapted to fit therein, and means for releasably retaining said needle end in said needle mount opening.

7. A surgical suturing instrument comprising a first handle, a second handle movably mounted on said first handle, a rotatable shaft, motion-transmitting means interconnecting said shaft and said second handle whereby movement of said second handle from a first to a second position causes rotation of said shaft, and needle means including a needle and a needle mount affixed to said shaft and rotatable therewith whereby movement of said second handle affects rotation of said needle, said needle mount further including means for releasably and rigidly retaining said needle therein in tight frictional engagement therewith, said needle including suture retaining means for retaining a suture therein, said needle being arcuate in shape and including a pointed end, said suture-retaining means comprising a slot adjacent said pointed end, said slot having a restricted entrance thereto through the inner wall of said arcuate needle, and being closed by the outer wall of said arcuate needle, and an enlarged interior portion to prevent accidental removal of the suture retained in said slot.

8. A curved needle having an inner and and outer circumferential wall and having a first end adapted to be attached to a surgical suturing instrument, a second pointed end adapted to pierce tissue, and a single slot in said needle near said second end adapted to retain a suture therein, said slot being accessible through a restricted opening in the said inner wall and closed by said outer wall, and an enlarged interior portion to prevent accidental removal of the suture.

9. A needle as in claim 8, in which said needle is arcuate in shape and said slot opens radially inwardly of said needle.

10. A needle as in claim 9, in which said needle subtends an arc of substantially 270 and said slot is positioned substantially 3045 behind said second end. 

1. A surgical suturing instrument comprising a first handle, a second handle movably mounted on said first handle, a rotatable shaft, motion-transmitting means interconnecting said shaft and said second handle whereby movement of said second handle from a first to a second position causes rotatioN of said shaft, and needle means including a needle and a needle mount affixed to said shaft and rotatable therewith whereby movement of said second handle affects rotation of said needle, said needle mount further including means for releasably and rigidly retaining said needle therein in tight frictional engagement therewith, said needle including suture retaining means for receiving a suture therein, said first handle being hollow and forming an enclosed housing, said motion-transmitting means being encased within said hollow handle housing and including a first gear connected to said second handle and being movable in response to movement of said second handle from said first to said second position, and a second gear connected to said shaft and in meshing engagement with said first gear to transmit motion of said first gear to said shaft.
 2. A surgical suturing instrument as in claim 1, in which said first handle is provided with a thumb-receiving portion, said thumb-receiving portion including an inclined wall which slopes outwardly and forwardly from one surface of said first handle to the opposite surface of said handle and which is adapted to abut the fleshy base of the thumb when the suturing instrument is held in the hand of an operator.
 3. A surgical suturing instrument comprising a first handle, a second handle movably mounted on said first handle, a rotatable shaft, motion transmitting means interconnecting said shaft and said second handle whereby movement of said second handle from a first to a second position causes rotation of said shaft, needle means including a needle affixed to said shaft and rotatable therewith whereby movement of said second handle affects rotation of said needle, said needle including suture retaining means for receiving a suture therein, said needle means further including a needle mount for releasably connecting said needle with said shaft, mounting means for mounting said needle mount on said first handle, and connecting means for connecting said needle mount with said shaft whereby said needle mount is rotatable with said shaft.
 4. A surgical suturing instrument as in claim 3, in which said mounting means includes a reduced diameter portion extending outwardly from said first handle, a recess in said needle mount sized and positioned to receive said reduced diameter portion of said first handle, and retaining means on said needle mount and said reduced diameter portion for retaining said needle mount on said reduced diameter portion.
 5. A surgical suturing instrument as in claim 3, in which said connecting means includes a radially extending cross member connected to said shaft, and at least one slot in said needle mount adapted to receive said cross member therein.
 6. A surgical suturing instrument as in claim 3, in which said needle mount includes an opening having a predetermined geometric shape adjacent the end thereof, said needle having an end formed complementary to said needle mount opening and being adapted to fit therein, and means for releasably retaining said needle end in said needle mount opening.
 7. A surgical suturing instrument comprising a first handle, a second handle movably mounted on said first handle, a rotatable shaft, motion-transmitting means interconnecting said shaft and said second handle whereby movement of said second handle from a first to a second position causes rotation of said shaft, and needle means including a needle and a needle mount affixed to said shaft and rotatable therewith whereby movement of said second handle affects rotation of said needle, said needle mount further including means for releasably and rigidly retaining said needle therein in tight frictional engagement therewith, said needle including suture retaining means for retaining a suture therein, said needle being arcuate in shape and including a pointed end, said suture-retaining means comprising a slot adjacent said pointed end, said slot having a restricted entrance thereto through the inner wall of said arcuaTe needle, and being closed by the outer wall of said arcuate needle, and an enlarged interior portion to prevent accidental removal of the suture retained in said slot.
 8. A curved needle having an inner and and outer circumferential wall and having a first end adapted to be attached to a surgical suturing instrument, a second pointed end adapted to pierce tissue, and a single slot in said needle near said second end adapted to retain a suture therein, said slot being accessible through a restricted opening in the said inner wall and closed by said outer wall, and an enlarged interior portion to prevent accidental removal of the suture.
 9. A needle as in claim 8, in which said needle is arcuate in shape and said slot opens radially inwardly of said needle.
 10. A needle as in claim 9, in which said needle subtends an arc of substantially 270* and said slot is positioned substantially 30*-45* behind said second end. 